Case finding in Shandong Province, China

DOTS strategy has been introduced into Shandong Province, China and was successfully expended to cover 100% of its the population. In comparison with the high cure rate achieved under DOTS strategy, case finding especially finding of smear positive pulmonary tuberculosis cases in Shandong was far from ideal. The objectives of this study is to review current china’s genera services and TB services in order to identify contributing factors to low case finding, to review and appraise international literatures, and to make recommendations to Shandong Tuberculosis control Center. This study mainly drew upon secondary data that includes literature database, governmental documents, and personal experiences.

Generally, health services in China are decentralized to local governments. Tuberculosis services facilities in Shandong have vertical liaison between upper and lower level in terms of technical supervision and drug supply; while they are funded by accountable to local governments (except drugs).

Detecting TB patients self presented at TB dispensaries and registering patients referred from general health facilities are the current main approaches for case finding, but there are problems. People’s Low awareness about tuberculosis and health facilities’ poor accessibility account for tuberculosis patients’ inadequate self referral. No sound TB case referring and notification mechanisms in place promoting case referral from public sectors, and private for profits health facilities have not involved in TB case referring. Diagnosis procedure and capacity are problematic both at specialized tuberculosis dispensaries and general health facilities. Attempts of active case finding have not been made currently.

International literatures showed that awareness about tuberculosis can be raised through health education campaign; decentralizing tuberculosis services to primary health level may improve patients’ accessibility. Involving community health workers can actively finding tuberculosis suspects; Detecting TB patients from household contacts of smear positive cases are efficient when the contacts have chronic cough. Chest X-ray is not inclusive in diagnosing tuberculosis, while sputum microscopy is efficient in identifying infectious TB patients. PAL can help general services more effectively finding TB cases. Involving private sector is possible and feasible. Improve governmental commitment to tuberculosis control is vital.

These international experiences were appraised against the background of Shandong province in terms their practicality and feasibility. Recommendations were made basing on the appraisal. Systematic health education plan need to be developed based on the perceptions and beliefs of local community, and the education should be lasting; role of sputum test should be stressed; village doctor should take an active role in identifying tuberculosis suspects; tracing properly selected household contacts should be undertaken; adequate referral system should be set up that involve private sectors. Local tuberculosis dispensaries should carry out advocacy activities under the leadership and assistant from provincial tuberculosis center.